Provider Demographics
NPI:1760701726
Name:ASPYR SPEECH LANGUAGE PATHOLOGY SERVICES, PC
Entity Type:Organization
Organization Name:ASPYR SPEECH LANGUAGE PATHOLOGY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:646-325-8889
Mailing Address - Street 1:14212 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2240
Mailing Address - Country:US
Mailing Address - Phone:646-325-8889
Mailing Address - Fax:347-410-8174
Practice Address - Street 1:6143 186TH ST
Practice Address - Street 2:SUITE C113/114
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2710
Practice Address - Country:US
Practice Address - Phone:646-325-8889
Practice Address - Fax:347-410-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty